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///2018 Abstract Details
2018 Abstract Details2019-08-02T15:57:01-05:00

Safer Anaesthesia From Education (SAFE) Obstetric training in Kenya

Abstract Number: F1A-3
Abstract Type: Original Research

Maytinee Lilaonitkul MBBS, BSc, FRCA1 ; Naomi Pritchard MBCHB, BSc, MSc, FRCA2; Eric Bhoyyo Kibet MBChB3; Patrick Olang' MBChB, MMed, Fell Obs Anaes(Durban)4; Phoebe Khagame BSc5; Isabeau Walker BSc MB BChir FRCA6


Maternal mortality rate (MMR) remains unacceptably high in low-income countries (LIC). More than 300,000 deaths occur during childbirth each year, 99% of these in LICs. The leading causes of maternal death are hemorrhage, hypertensive disorders and sepsis.

Kenya is a country in East Africa with MMR of 488 per 100,000 live births. Obstetric anesthesia care is mainly provided by non-physician anesthetists who work in remote areas with limited opportunities for continuing medical education.

The Association of Anaesthetists of Great Britain and Ireland (AAGBI) and World Federation of Societies of Anaesthesiologists (WFSA) developed the 3-day SAFE Obstetric Anaesthesia course to provide refresher training for anaesthetists in LICs. The course addresses the major causes of maternal death and essential skills in obstetric anaesthesia.

The aim of the SAFE Kenya project was to deliver a national SAFE training programme in partnership with the Kenyan Society of Anaesthesiologists and provide follow-up mentorship for course participants. The initial impact of training is reported here.


Experienced anesthetists from East Africa, South Africa, UK and US delivered the first SAFE course in Nairobi Kenya in 2016. The course was preceded by a one-day Training-of-Trainers (TOT) course to increase local training capacity. Three further regional courses were delivered with minimal external faculty support.

Pre- and post-course knowledge and skills tests were conducted for each course. A UK SAFE fellow conducted mentoring visits at 6 months in the participants’ workplace. Face-to-face structured interview, facility capacity survey and operating room record review were carried out.


A total of 173 anesthestists underwent SAFE training and 24 completed the TOT course.

66 hospital visits were made in all regions of Kenya, and 103 participants interviewed. The median years of anesthesia practice was 7 (IQR 4-13). 35/103 (34%) had received no CME since training. Operating room records showed that 50.6% of 24009 procedures in previous 3 months were cesarean section.

Mean MCQ scores increased from 40/50 to 43/50 post-course, maintained at 6 months (P<0.001). Mean skill scores increased from 5/10 to 8/10 post-course and 7/10 at 6 months (P<0.001).

The participants stated that the most useful training modules were newborn resuscitation, pre-eclampsia and management of hemorrhage.

Emerging themes from structured interviews included improved clinical practice, team communication and confidence.


SAFE Obstetrics course provides structured refresher training for anesthetists in LICs. The results from Kenya demonstrate knowledge and skill retention and improved clinical confidence. Through networking, TOT and mentorship, the SAFE model helped to foster professional relationships within Kenya and internationally. Future steps include integration of SAFE training into the curriculum for all non-physician anesthetists.

SOAP 2018